Long term effect of a medical emergency team on cardiac arrests in a teaching hospital.


INTRODUCTION:It is unknown whether the reported short-term reduction in cardiac arrests associated with the introduction of the medical emergency team (MET) system can be sustained. METHOD:We conducted a prospective, controlled before-and-after examination of the effect of a MET system on the long-term incidence of cardiac arrests. We included consecutive patients admitted during three study periods: before the introduction of the MET; during the education phase preceding the implementation of the MET; and a period of four years from the implementation of the MET system. Cardiac arrests were identified from a log book of cardiac arrest calls and cross-referenced with case report forms and the intensive care unit admissions database. We measured the number of hospital admissions and MET reviews during each period, performed multivariate logistic regression analysis to identify predictors of mortality following cardiac arrest and studied the correlation between the rate of MET calls with the rate of cardiac arrests. RESULTS:Before the introduction of the MET system there were 66 cardiac arrests and 16,246 admissions (4.06 cardiac arrests per 1,000 admissions). During the education period, the incidence of cardiac arrests decreased to 2.45 per 1,000 admissions (odds ratio (OR) for cardiac arrest 0.60; 95% confidence interval (CI) 0.43-0.86; p = 0.004). After the implementation of the MET system, the incidence of cardiac arrests further decreased to 1.90 per 1,000 admissions (OR for cardiac arrest 0.47; 95% CI 0.35-0.62; p < 0.0001). There was an inverse correlation between the number of MET calls in each calendar year and the number of cardiac arrests for the same year (r2 = 0.84; p = 0.01), with 17 MET calls being associated with one less cardiac arrest. Male gender (OR 2.88; 95% CI 1.34-6.19) and an initial rhythm of either asystole (OR 7.58; 95% CI 3.15-18.25; p < 0.0001) or pulseless electrical activity (OR 4.09; 95% CI 1.59-10.51; p = 0.003) predicted an increased risk of death. CONCLUSION:Introduction of a MET system into a teaching hospital was associated with a sustained and progressive reduction in cardiac arrests over a four year period. Our findings show sustainability and suggest that, for every 17 MET calls, one cardiac arrest might be prevented.


Crit Care


Jones D,Bellomo R,Bates S,Warrillow S,Goldsmith D,Hart G,Opdam H,Gutteridge G





Has Abstract


2005-01-01 00:00:00














  • Recently published papers: from superbugs to superbowl.

    abstract::Several papers are discussed including the CARP (Coronary Artery Revascularisation Prophylaxis) trial, examining the role, if any, of preoperative coronary revascularisation and a study examining the heart rate in the intensive care unit (ICU) population. We also take a look at infections in the ICU with particular re...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章


    authors: Tomlinson LA,Forni LG

    更新日期:2005-04-01 00:00:00

  • Pre-admission functional status impacts the performance of the APACHE IV model of mortality prediction in critically ill patients.

    abstract:BACKGROUND:Functional status (FS) before intensive care unit (ICU) admission is associated with short-term and long-term outcomes among critically ill patients. However, measures of FS are generally not integrated into ICU-specific mortality prediction models. METHODS:This retrospective cohort study used prospectively...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章


    authors: Krinsley JS,Wasser T,Kang G,Bagshaw SM

    更新日期:2017-05-15 00:00:00

  • Gut-liver crosstalk in sepsis-induced liver injury.

    abstract::Sepsis is characterized by a dysregulated immune response to infection leading to life-threatening organ dysfunction. Sepsis-induced liver injury is recognized as a powerful independent predictor of mortality in the intensive care unit. During systemic infections, the liver regulates immune defenses via bacterial clea...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章,评审


    authors: Sun J,Zhang J,Wang X,Ji F,Ronco C,Tian J,Yin Y

    更新日期:2020-10-19 00:00:00

  • Early goal-directed resuscitation of patients with septic shock: current evidence and future directions.

    abstract::Severe sepsis and septic shock are among the leading causes of mortality in the intensive care unit. Over a decade ago, early goal-directed therapy (EGDT) emerged as a novel approach for reducing sepsis mortality and was incorporated into guidelines published by the international Surviving Sepsis Campaign. In addition...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章,评审


    authors: Gupta RG,Hartigan SM,Kashiouris MG,Sessler CN,Bearman GM

    更新日期:2015-08-28 00:00:00

  • So much to teach, so little time: a prospective cohort study evaluating a tool to select content for a critical care curriculum.

    abstract:INTRODUCTION:Curricular content is often based on the personal opinions of a small number of individuals. Although convenient, such curricula may not meet the needs of the target learner, the program or the institution. Using an objective method to ensure content validity of a curriculum can alleviate this issue. METH...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章


    authors: Peets AD,McLaughlin K,Lockyer J,Donnon T

    更新日期:2008-01-01 00:00:00

  • Eubaric hyperoxia: controversies in the management of acute traumatic brain injury.

    abstract::Controversy exists on the role of hyperoxia in major trauma with brain injury. Hyperoxia on arterial blood gas has been associated with acute lung injury and pulmonary complications, impacting clinical outcome. The hyperoxia could be reflective of the physiological interventions following major systemic trauma. Despit...

    journal_title:Critical care (London, England)

    pub_type: 评论,杂志文章


    authors: Narotam PK

    更新日期:2013-10-16 00:00:00

  • Bench-to-bedside review: Natural killer cells in sepsis - guilty or not guilty?

    abstract::Bacterial sepsis and septic shock are complex inflammatory disorders associated with a systemic inflammatory response syndrome. In the most severe cases of infection, an overzealous release of pro-inflammatory cytokines and inflammatory mediators by activated leukocytes, epithelial cells and endothelial cells, known a...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章,评审


    authors: Souza-Fonseca-Guimaraes F,Cavaillon JM,Adib-Conquy M

    更新日期:2013-08-27 00:00:00

  • Moderate hyperoxic versus near-physiological oxygen targets during and after coronary artery bypass surgery: a randomised controlled trial.

    abstract:BACKGROUND:The safety of perioperative hyperoxia is currently unclear. Previous studies in patients undergoing coronary artery bypass surgery suggest reduced myocardial damage when avoiding extreme perioperative hyperoxia (>400 mmHg). In this study we investigated whether an oxygenation strategy from moderate hyperoxia...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章,随机对照试验


    authors: Smit B,Smulders YM,de Waard MC,Boer C,Vonk AB,Veerhoek D,Kamminga S,de Grooth HJ,García-Vallejo JJ,Musters RJ,Girbes AR,Oudemans-van Straaten HM,Spoelstra-de Man AM

    更新日期:2016-03-10 00:00:00

  • Endothelin antagonists in subarachnoid hemorrhage: what next?

    abstract::In the previous issue of Critical Care, Ma and colleagues perform a meta-analysis of five randomized, clinical trials of endothelin antagonists in patients with aneurysmal subarachnoid hemorrhage. There are four trials using clazosentan and one trial with TAK-044. These studies show that endothelin plays an important ...

    journal_title:Critical care (London, England)

    pub_type: 评论,杂志文章


    authors: Macdonald RL

    更新日期:2012-11-09 00:00:00

  • Normal adrenocortical function on initial testing in the intensive care unit: not a long-term warranty.

    abstract::There has been a lot of debate about the concept of relative adrenocortical insufficiency (often defined as a reduced response to corticotropin) as a pathophysiological explanation of steroid effects in septic shock. Less is known about the prevalence of absolute adrenocortical insufficiency based on more usual defini...

    journal_title:Critical care (London, England)

    pub_type: 评论,社论


    authors: Bollaert PE

    更新日期:2008-01-01 00:00:00

  • Capnometry in suspected pulmonary embolism with positive D-dimer in the field.

    abstract:INTRODUCTION:Pulmonary embolism (PE) is one of the greatest diagnostic challenges in prehospital emergency setting. Most patients with suspected PE have a positive D-dimer and undergo diagnostic testing. Excluding PE with additional non-invasive tests would reduce the need for further imaging tests. We aimed to determi...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章


    authors: Rumpf TH,Krizmaric M,Grmec S

    更新日期:2009-01-01 00:00:00

  • Tracheal extubation and reintubation of the critically ill--challenges coming and going.

    abstract::Tracheal reintubation is a common event in critical care. Elmer and colleagues provide the first comparison of complication rates of initial and subsequent reintubation(s) during the same hospitalization. Their work shows an increased risk of complications associated with reintubation, in particular hypoxemia and hypo...

    journal_title:Critical care (London, England)

    pub_type: 评论,杂志文章


    authors: Parotto M,Cooper RM

    更新日期:2015-03-27 00:00:00

  • Procalcitonin as a marker of bacterial infection in the emergency department: an observational study.

    abstract:INTRODUCTION:Procalcitonin (PCT) has been proposed as a marker of infection in critically ill patients; its level is related to the severity of infection. We evaluated the value of PCT as a marker of bacterial infection for emergency department patients. METHODS:This prospective observational study consecutively enrol...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章


    authors: Chan YL,Tseng CP,Tsay PK,Chang SS,Chiu TF,Chen JC

    更新日期:2004-02-01 00:00:00

  • Organ donation and the ethics of muddling through.

    abstract::Organ donation offers opportunities for people in critical care units to help save the lives of other patients. It is not always easy, however, to handle the transition from treating a patient to preserving a potential donor, and organ donation consistently provokes ethical questions in critical care units. What do we...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章,评审


    authors: Hoeyer K,Jensen AM

    更新日期:2011-01-24 00:00:00

  • In vivo calibration of esophageal pressure in the mechanically ventilated patient makes measurements reliable.

    abstract:BACKGROUND:Esophageal pressure (Pes) can provide information to guide mechanical ventilation in acute respiratory failure. However, both relative changes and absolute values of Pes can be affected by inappropriate filling of the esophageal balloon and by the elastance of the esophagus wall. We evaluated the feasibility...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章


    authors: Mojoli F,Iotti GA,Torriglia F,Pozzi M,Volta CA,Bianzina S,Braschi A,Brochard L

    更新日期:2016-04-11 00:00:00

  • Still a man's world, but why?

    abstract::Women are generally under-represented in many academic medical settings. Through a brief commentary on this issue, the present article discusses possible explanations for this under-representation as well as potential solutions. Issues examined include women in leadership positions, attrition out of academic medicine,...

    journal_title:Critical care (London, England)

    pub_type: 评论,杂志文章


    authors: Weinacker A,Stapleton RD

    更新日期:2013-01-29 00:00:00

  • Feasibility and reliability of an automated controller of inspired oxygen concentration during mechanical ventilation.

    abstract:INTRODUCTION:Hypoxemia and high fractions of inspired oxygen (FiO2) are concerns in critically ill patients. An automated FiO2 controller based on continuous oxygen saturation (SpO2) measurement was tested. Two different SpO2-FiO2 feedback open loops, designed to react differently based on the level of hypoxemia, were ...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章


    authors: Saihi K,Richard JC,Gonin X,Krüger T,Dojat M,Brochard L

    更新日期:2014-02-19 00:00:00

  • The administration of dextrose during in-hospital cardiac arrest is associated with increased mortality and neurologic morbidity.

    abstract:INTRODUCTION:Dextrose may be used during cardiac arrest resuscitation to prevent or reverse hypoglycemia. However, the incidence of dextrose administration during cardiac arrest and the association of dextrose administration with survival and other outcomes are unknown. METHODS:We used the Get With The Guidelines®-Res...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章


    authors: Peng TJ,Andersen LW,Saindon BZ,Giberson TA,Kim WY,Berg K,Novack V,Donnino MW,American Heart Association’s Get With The Guidelines®-Resuscitation Investigators.

    更新日期:2015-04-10 00:00:00

  • A supplemental intravenous amino acid infusion sustains a positive protein balance for 24 hours in critically ill patients.

    abstract:BACKGROUND:Providing supplemental amino acids to ICU patients during a 3-h period results in improved whole-body net protein balance, without an increase in amino acid oxidation. The primary objective was to investigate if a 24-h intravenous amino acid infusion in critically ill patients has a sustained effect on whole...

    journal_title:Critical care (London, England)

    pub_type: 临床试验,杂志文章


    authors: Sundström Rehal M,Liebau F,Tjäder I,Norberg Å,Rooyackers O,Wernerman J

    更新日期:2017-12-06 00:00:00

  • First evidence of a pro-inflammatory response to severe infection with influenza virus H1N1.

    abstract::The great majority of infections caused by the pandemic variant of the influenza virus (nvH1N1) are self-limited, but a small percentage of patients develop severe symptoms requiring hospitalization. Bermejo-Martin and colleagues have presented a pilot study describing the differences in the early immune response for ...

    journal_title:Critical care (London, England)

    pub_type: 评论,信件


    authors: de Castro IF,Guzmán-Fulgencio M,García-Alvarez M,Resino S

    更新日期:2010-01-01 00:00:00

  • Clinical review: Prognostic value of magnetic resonance imaging in acute brain injury and coma.

    abstract::Progress in management of critically ill neurological patients has led to improved survival rates. However, severe residual neurological impairment, such as persistent coma, occurs in some survivors. This raises concerns about whether it is ethically appropriate to apply aggressive care routinely, which is also associ...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章,评审


    authors: Weiss N,Galanaud D,Carpentier A,Naccache L,Puybasset L

    更新日期:2007-01-01 00:00:00

  • Prevalence of burnout among intensivists in mainland China: a nationwide cross-sectional survey.

    abstract:BACKGROUND:Burnout has gained increasing attention worldwide; however, there is a lack of relevant research in China. This study investigated the prevalence and factors associated with burnout in physicians of the intensive care unit (ICU) in mainland China. METHODS:This cross-sectional multicenter study included crit...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章


    authors: Wang J,Hu B,Peng Z,Song H,Cai S,Rao X,Li L,Li J

    更新日期:2021-01-05 00:00:00

  • Mechanical ventilation interacts with endotoxemia to induce extrapulmonary organ dysfunction.

    abstract:INTRODUCTION:Multiple organ dysfunction syndrome (MODS) is a common complication of sepsis in mechanically ventilated patients with acute respiratory distress syndrome, but the links between mechanical ventilation and MODS are unclear. Our goal was to determine whether a minimally injurious mechanical ventilation strat...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章


    authors: O'Mahony DS,Liles WC,Altemeier WA,Dhanireddy S,Frevert CW,Liggitt D,Martin TR,Matute-Bello G

    更新日期:2006-01-01 00:00:00

  • Prediction of fluid challenge effect: filling pressure when left ventricular function is abnormal, diastolic volume when left ventricular function is normal.

    abstract::Fluid resuscitation is a cornerstone of intensive care unit patient care, but prediction of the cardiovascular response remains difficult, despite many efforts in clinical research. The concept of responders and nonresponders illustrates such a difficulty. Many techniques have been tested, from strictly non-invasive t...

    journal_title:Critical care (London, England)

    pub_type: 评论,杂志文章


    authors: Payen D

    更新日期:2011-01-01 00:00:00

  • Central venous oxygenation: when physiology explains apparent discrepancies.

    abstract::Central venous oxygen saturation (ScvO2) >70% or mixed venous oxygen saturation (SvO2) >65% is recommended for both septic and non-septic patients. Although it is the task of experts to suggest clear and simple guidelines, there is a risk of reducing critical care to these simple recommendations. This article reviews ...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章,评审


    authors: Squara P

    更新日期:2014-11-10 00:00:00

  • The International Sepsis Forum's controversies in sepsis: corticosteroids should be used to treat septic shock.

    abstract::The use of corticosteroids in septic shock remains controversial. It has been demonstrated that high doses of steroids (30 mg/kg methylprednisolone) for short periods of time are not beneficial. More recent studies using smaller doses (200-300 mg/day hydrocortisone) for longer periods of time have shown beneficial eff...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章,评审


    authors: Goodman S,Sprung CL,International Sepsis Forum.

    更新日期:2002-10-01 00:00:00

  • The diagnosis of adrenal insufficiency in the critically ill patient: does it really matter?

    abstract::The definition of what constitutes a 'normal' adrenal response to critical illness is unclear. Consequently, published studies have used a variety of biochemical criteria to define 'adrenal insufficiency'. These criteria have been based on the baseline cortisol level or the increment in cortisol following corticotropi...

    journal_title:Critical care (London, England)

    pub_type: 评论,杂志文章


    authors: Marik PE

    更新日期:2006-01-01 00:00:00

  • Current place of probiotics for VAP.

    abstract:: ...

    journal_title:Critical care (London, England)

    pub_type: 评论,社论


    authors: Virk HS,Wiersinga WJ

    更新日期:2019-02-13 00:00:00

  • Immune derangement occurs in patients with H7N9 avian influenza.

    abstract:INTRODUCTION:Currently, little is known about the immunological characteristics of patients with avian influenza A (H7N9) virus infection. METHODS:The numbers and percentages of peripheral blood immune cells were measured in 27 patients with laboratory-confirmed H7N9 virus infection and 30 healthy controls (HCs). The ...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章


    authors: Wu W,Shi Y,Gao H,Liang W,Sheng J,Li L

    更新日期:2014-03-24 00:00:00

  • Clinical review: how to identify high-risk surgical patients.

    abstract::Postoperative outcome is mainly influenced by ventricular function. Tests designed to identify myocardial ischemia alone will fail to detect cardiac failure and are thus inadequate as a screening test for identification of cardiac risk in noncardiac surgical patients. We find that the degree of cardiac failure is the ...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章,评审


    authors: Older P,Hall A

    更新日期:2004-10-01 00:00:00